Morbidity and drug prescribing patterns at a rural primary health care center of Bangladesh

Abstract

Background and objectives: World Health Organization (WHO) and the National Health Policy of Bangladesh have repeatedly been emphasizing on the use of essential drugs prescribed by generic names. The prescription monitoring studies provide a bridge between areas like rational use of drugs and evidence based medicine. Knowledge on distribution and burden of diseases in a community is essential for planning rational use of drugs in a community. The present study tried to determine the morbidity profile and drug prescribing practices of healthcare providers in a rural primary health care.
 Methods: The study was conducted at a rural health center located 50 Km north of capital city Dhaka. A semi-structured questionnaire was used for collecting data on socio-demographic conditions, clinical complaints and types of drugs prescribed. WHO prescribing indicators was used to find out the drug prescribing pattern.
 Results: A total of 583 patients were enrolled. Problems related to respiratory system (21.1%), musculoskeletal system (17.3%) and skin diseases (11.1%) were common reasons for visiting health centre. Oral drugs were prescribed with highest proportion (96.1%). More than half (62.6%) of the drugs were prescribed from essential drug list. About half (49.1%) were antibiotics and 45.6% of the drugs were prescribed in their generic name. Anti-microbial (64.5%), anti-peptic ulcer (43.1%) and NSAIDs (42.5%) were most frequently prescribed. Out of five WHO core prescription indicators, four were below the acceptable values.
 Conclusion: The study demonstrated that there is an urgent need to promote rational use of drugs among the healthcare providers.
 IMC J Med Sci 2018; 12(2): 50-56

Study on drug use pattern in primary healthcare centers of Kathmandu valley

“…4 The study revealed that the average number of drugs per encounter was 2.6, which was higher than the optimal value but lower than PHCs in Bangladesh (3.31), Pakistan (3.4), and Egypt (2.5). 3,11,16 The maximum prescription (43%) contained three drugs, which is similar to PHCs in Madhya Pradesh, India, where maximum patients (37.3%) had three drugs. 17 The study showed a maximum of six drugs per patient.…”

“…The WHO strongly recommends prescribing in generic names as a safety precaution for patients because it identifies the drug clearly, enables better information exchange, and allows better communication between healthcare providers. 16 However, generic prescribing was low (60%) compared to PHCs of Pakistan (71.6%), Egypt (95.4%), and Madhya Pradesh, India (60.9%) and higher compared to PHCs of Bangladesh (45.6%) and a recent study of Nepal (57.52%). 3,10,11,16,17 In PHCs, 58 drugs were available for free as per government provision; therefore, whatever the brand name prescriber used in prescription, the medicines available in PHCs, of whichever brand name, are dispensed to the patient.…”

“…16 However, generic prescribing was low (60%) compared to PHCs of Pakistan (71.6%), Egypt (95.4%), and Madhya Pradesh, India (60.9%) and higher compared to PHCs of Bangladesh (45.6%) and a recent study of Nepal (57.52%). 3,10,11,16,17 In PHCs, 58 drugs were available for free as per government provision; therefore, whatever the brand name prescriber used in prescription, the medicines available in PHCs, of whichever brand name, are dispensed to the patient. Higher brand prescription in PHCs reflects the influence of pharmaceutical companies or prescriber's higher faith in particular manufacturer products.…”

“…The result was far less than other studies conducted in PHCs of Pakistan (27.1%), PHCs of Bangladesh (13.6%), and optimal value (13.4%-24.1%). 3,16 The lower uses of parenteral in PHCs signify the nature of patient's illness and PHCs' practice on parenteral prescribing. On the other hand, lower use of parenteral reduces the possibility of bloodborne diseases and cost of therapy.…”

A Study on Medicine Utilization Pattern in Outpatient Departments of Tertiary Care Centre in Kathmandu

“…10 This is lower than reported by Dahal et al (59.02%), 19 Ferreira et al (86%), 20 Desalegn et al (98.7%) 21 and Momtaz et al (45.6%). 22 WHO always promotes the use of generic name of medicines as they are cheaper than branded substitutes and have equal efficacy and potency. The lower rate in Nepal may be due to the influence of local and international pharmaceutical companies on physicians' decisions.…”